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Sunday, March 5, 2017

Canada's program that aims to prevent pregnancy in women who use the powerful acne drug isotretinoin (Accutane) is not effective, found a new study in CMAJ (Canadian Medical Association Journal).

Of the women taking the drug, 30% to 50% do not comply with the program's requirements, which, given the severe harm the drug can cause to a fetus, represents poor performance of the pregnancy prevention program.

"Poor adherence with the Canadian pregnancy prevention guidelines means that Canada, inadvertently, is using pregnancy termination rather than pregnancy prevention to manage fetal risk from isotretinoin," states lead author Dr. David Henry, senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and executive co-lead of the Canadian Network for Observational Drug Effect Studies (CNODES). "It appears that not all doctors and patients are sticking closely to the guidelines to prevent pregnancy during treatment with isotretinoin."

Isotretinoin (commonly marketed as Accutane when first released) is used to treat severe acne and has been approved in Canada since 1983. It can severely harm a fetus, causing craniofacial, cardiac and central nervous system defects, as well as a high likelihood of miscarriage or medical termination. The average age of isotretinoin users in Canada is estimated to be 24 years, and half of all prescriptions are written for females.

Canada's program recommends informed written consent, two negative pregnancy tests before beginning treatment and the use of two reliable birth control methods during treatment.

Researchers looked at anonymized patient records for 59,271 women taking isotretinoin aged 12 to 48 years in four Canadian provinces -- British Columbia, Saskatchewan, Manitoba and Ontario -- between 1996 and 2011. Over the 15-year study period, there were 1473 pregnancies, 118 (8%) of which resulted in live births; of those, 11 (9%) were identified as having congenital abnormalities.

Pregnancy rates during isotretinoin treatment ranged from 4 to 6/1000 users. The at-risk period for exposure extends beyond the end of treatment, and overall pregnancy rates including this later period were higher.

Despite the recommendations that women take strict precautions to prevent pregnancy while taking isotretinoin, the researchers found that only one-quarter to one-third of women filled birth control prescriptions while taking isotretinoin, nearly identical to rates in the previous 12 months. However, the researchers note that they were not able to track the use of birth control pills obtained without plan coverage (perhaps from a free clinic) or directly from a supply from a doctor, or the use of intrauterine devices or barrier methods.

"It is clear from this experience and from studies in Europe that modifying contraceptive behaviour in this setting is difficult," said Dr. Brandace Winquist, a coauthor of the study. Nevertheless, medical practitioners and patients must be constantly reminded of the risks of isotretinoin to the fetus and implement effective contraceptive measures."

Tuesday, January 31, 2017

It’s common knowledge that what we eat plays an important role in health, but a new report finds that when we eat is also significant.

A new statement from the American Heart Association suggests that eating more of your calories earlier in the day may help keep the heart healthy.

“People who consume breakfast on a regular basis have a lower risk of cardiovascular disease,” Dr. Marie-Pierre St-Onge, the author of the statement and a researcher at Columbia University Medical Center, told CBS News.

St-Onge points to studies that show eating earlier in the day – when your body can better metabolize food – may lower heart disease risk factors such as obesity, high blood pressure and high cholesterol.

“A calorie in the morning may not be the same as a calorie, in terms of how your body processes it, in the evening,” CBS News medical contributor Dr. Tara Narula said on “CBS This Morning” Tuesday.

“We’re learning that it’s because of the body’s internal clocks,” explained Narula, who is a cardiologist at Northwell Health. “We have a central clock in our brain that’s really dictated by light and dark, and that controls our sleep-wake cycles, our body temperature. But what’s more fascinating is that each of our individual tissues and organs have their own clocks, and those are turned on or off by feeding or fasting. And those genes essentially control how we process blood sugar, cholesterol, how our immune system functions, our digestive system.”

Like many Americans, Elena Alonzo used to constantly skip breakfast. Now, she makes sure to make time for it every day.

“I always thought I was not hungry and now I realize how much energy this actually gives me,” she said, making time for a breakfast of oatmeal, fruit and a smoothie at her desk.

Spreading out your day’s calories across smaller, more frequent meals also seems to benefit the heart.

“Consume a balanced diet, obviously, but if this can be done in the context of more frequent meals during the waking hours – not so close to bedtime, and earlier in the day – that would be the ideal,” St-Onge said.

She also recommends planning your meals, and avoiding eating due to stress, boredom, or fatigue.

For Alonzo, sticking to a breakfast routine is also important.

“If we don’t ritualize something it’s really easy for it to fall away,” she said.